Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 33005472A | IN |
NPI | 1003009994 |
---|---|
Provider Name | Beth Nicole Brown |
First Address | Vincennes, IN 47591-1034 |
Second Address | Vincennes, IN 47591-4277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 25/06/2008 |